Monday, July 13, 2009

In political combat, there are few more potent weapons than a single word or a catchy phrase that can be used to target a proposal and drive it into the ground.

For Republicans, “rationing” could be that poison-tipped arrow for the Democratic-led health care bill, much as “amnesty” was the club with which conservatives beat President Bush’s attempt at immigration reform into a bloody pulp in 2007.

“Governments ration care to control costs, and we’ve got stories from other countries where disabled children wait up to two years for wheelchairs. We’ve got a story that we found: a 76-year-old retiree pulled out their own teeth,” said Rep. Dave Camp, Michigan Republican and the ranking member on the House Ways and Means Committee.

“Government rationing is a scary proposition,” he said.

Sen. John Cornyn of Texas, chairman of the National Republican Senatorial Committee, echoed this point during a conference call Wednesday, warning that the government could get into the business of rationing health care, deciding how much Americans can get or can spend on it and denying people health care that exceeds some rationed amount.

“The rationing problem is very real in all this and I think that as the American people learn more and more about the proposals as we are now being allowed more time for them to engage on this issue, they are very, very much concerned,” he said.

But Democrats say the insurance companies are already rationing care and that the reforms they want would cover all those who are being denied coverage under the current system, as well as keep down costs through an intensive focus on which medical procedures and products deliver care most effectively.

Republicans say that under a government-run system, which they argue will result from the proposed option to buy insurance from the government, cost will come to be the dominant factor that defines “efficient care,” and thus Americans will be denied care with no recourse.

House Democrats plan to introduce their health care overhaul measure Monday and consider amendments later in the week. On Sunday’s talk shows, there was disagreement on whether Congress will finish work on the bill before adjourning for the August recess.

Sen. Judd Gregg, New Hampshire Republican, said on CNN that meeting the deadline was “highly unlikely” because the Senate Finance Committee had not completed a draft. Sen. Jon Kyl of Arizona, the Senate Republican whip, said flatly there was “no chance.”

Democrats were more circumspect.

Sen. Charles E. Schumer said on NBC’s “Meet the Press” that “we expect the House and Senate to have passed bills” before leaving Washington, though he doubted the legislation would be signed into law by that time. On CNN’s “State of the Union,” Sen. Kent Conrad of North Dakota said the bill likely would “be through the Finance Committee by the August recess,” and Sen. Debbie Stabenow of Michigan said the president should be “very pleased with the progress we’re making.”

“President Obama was right about one thing. He said if it’s not done quickly, it won’t be done at all. Why did he say that? Because the longer it hangs out there, the more the American people are skeptical, anxious and even in opposition to it,” Mr. Kyl said on ABC’s “This Week.”

But if Republicans lean too heavily on one-word slogans such as “rationing,” they risk playing into their opponents’ hands. The main line of attack now used by Democrats and their allied interest groups is to portray the Republicans as members of a do-nothing party, a sort of disloyal opposition.

“All they’re doing is saying ‘no’ to everything. They’re not putting up alternatives for anyone to look at,” said Eddie Vale, a spokesman for the AFL-CIO, which is working with Democrats on reform efforts.

Mr. Vale said that unlike the Republicans’ successful takedown of immigration reform using the “amnesty” argument, the “rationing” threat has “less bang for the buck” with the public.

In addition, talking about rationing can ricochet back on Republicans when it emerges that health care is already more or less rationed by insurance companies.

“What on earth is not rationed in this world?” Peter Peterson said in an exasperated tone during a recent TV appearance. The wealthy businessman and philanthropist has waged a public relations war for the past two years on the growing federal deficit and debt.

Republicans such as Rep. Paul D. Ryan of Wisconsin have concerns about government rationing but do not want their argument to be pegged as simply a scare tactic. Despite Democrats’ complaints that the Republican Party does not have a plan for health care reform, Mr. Ryan is sponsoring a comprehensive reform plan, and he acknowledged that the debate isn’t really about whether health care is rationed or not.

“The question is: Who does it? Is it the government or is it the patient, the doctor, along with their insurance?” Mr. Ryan said. “You do not want to put these kinds of decisions in the hands of the federal government.”

Mr. Ryan’s Patients’ Choice Act of 2009 would, in his words, give most power over rationing to the patient, instead of either the insurance company or the government.

Mr. Obama also used the term “self-rationing” to describe what would happen if employer-provided benefits were taxed, as key lawmakers have said they want to do.

While Mr. Ryan’s plan would include a tax on employer-provided benefits, that money would go toward refundable tax credits of $2,300 for every individual and $5,700 per family instead of going into government coffers. Mr. Ryan calls it “delinking the tax exclusion from the job and giving it to the person.”

Although it is generally agreed that health care already is rationed, some insist that the Democrats’ reform plan, including a government-run “public option” for insurance, would eliminate rationing altogether.

“Nobody on the Democratic side is talking about putting anything into effect that would ration care. It’s a totally bogus argument,” said Jacki Schechner, a spokeswoman for advocacy group Health Care for America Now. “The state of our health care system right now is atrocious, and people are denied the care they need every day.”

Democratic lawmakers and activists argue that their plans likely will include comparative effectiveness research, or studies to help the government and industry determine the most effective treatment methods for diseases and illnesses.

“We’re trying to figure out what treatments are best for people,” Ms. Schechner said.

Many conservatives argue that, based on programs in European countries, the only way the government can provide less expensive health coverage than private insurers is by rationing care. They argue that the government will use the research to determine the best and only source of treatment for each health problem.

“The only way you can do that is restricting access or taking it out on providers,” said Dennis Smith, a senior research fellow at the Center for Health Policy Studies at the Heritage Foundation. “Bending the curve means we’re going to put restrictions on new medical advances.”

And health care analysts say that private insurance is already funding research to find effective and less costly medical treatment.

“Historically, whenever there’s been research for the best kind of care, the entities that have moved the fastest to deal with it has not been the federal government, but the insurance companies,” said Julius W. Hobson Jr., a senior policy adviser at Bryan Cave LLP.

But all this presupposes that the inclusion of a government-run insurance option - which is not a lock to be part of the final bill - will crowd out private companies and leave the government in control of the health care industry.

Mr. Obama has already signed off on more than $1 billion for federal research as part of the $787 billion stimulus act passed in February. The funding is to be used to conduct research that compares the outcomes of procedures to prevent, treat or diagnose diseases or conditions.

The legislation specifies that the research cannot be used to deny treatment to Medicare patients, a move that likely would pacify some Republican concerns over including it in the reform bill.

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